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Question
Posted by: Sanet | 2012-04-25

Post 651

What you will discover about Discovery is that they are just as sneaky Employers as what they are a Medical Scheme. In 2005 they offered me a position, I declined due to salary. They made a better offer and I accepted. 1 day before I started work there, I was called in with about 30 other people that would work the after hours call center and told. Sorry, we no longer have your positions available. I was supposed to do pre-auth. They gave us a spreadsheet with different options and the option with the highest salary still left me with a drop of R2700 in salary. Apparently they would only need the skill in 3 months time. Craziest thing, after my 6 weeks training they put us in the call centre and officially opened the after hours call centre in April. It was not 3 weeks, before there was such a demand for Pre-Auth, that they used their qualified staff to fill the positiions. And I was still earning my parhethic salary. And then I had to fight to go on training, and on my initial contract I would earn my negotiated salary immediately. Now I had to wait until my training for pre-auth was completed before I could get my higher salary!
They are sneaky bastards. I dropped them like a hot potatoe, and found another job, but stayed on as a member. They did not know what was coming. I''ve been milking them ever since. I use all my benefits every year, I''m in my above threshold Benefit by March already.
And, because I understand PMB''s, and call centre ethics I have succesfully won 2 cases at the Council for Medical Schemes.
Last year they paid for my In Hospital Doctor Consultation from my Out of Hospital Mental Health Benefit, which was already almost eshausted. Within 3 weeks all the claims were reversed.
Their letter: They erroneosly paid it from day to day. Shame! After several calls to the call centre and a Hello Peter. In which they even offered me the number of the CMS. They are sooo arrogant.
I think every member should sneak into their classes and get the background info, if only we could.
I''m a bit outdated now, but still find my way around.
And the Council for Medical Schemes are excellent.
Imagine how many people they con into believing benfits are not paid?
Thats my story, and thats why I know - pain block is paid mostly from hospital and partly from the above threshold benefit. Thus my choice to have it done. And have the problem sorted once and for all. Instead of depleting my much needed Mental Health Benefits with my Psychologist. If they did not change their benefit stucture, I would propably still be trying fisio and chiropractors. It is less painful and would have been less hassle. And the danger of affecting my mood would have been zero. But, you can''t get everything you want, sometimes you just have to beat them at their own game.

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Our expert says:
Expert ImageCyberShrink

Sounds like my experience, over the years, with ordinary insurance companies - the only major source o danger and damage you can't insure against, is damage caused by insutance companies.
A fried who's a GP in Durban tells me some of the Medical Aids are paying patients directly for his services, leaving it up to them to pay the doctor for the servies he has already provided - or not, if they choose to spend the cash on something else. Sounds odd, too.

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2
Our users say:
Posted by: Sanet | 2012-04-27

Discovery does the same, if the Dr does not claim Discovery Heath Rates. They basically force Drs to charge their rates, otherwise the Dr will not see his money.
You friend must just run a private practice, cash and that''s it. Very few people aere disciplined to pay their Dr when they receive the money from the fund.

Reply to Sanet
Posted by: cybershrink | 2012-04-25

Sounds like my experience, over the years, with ordinary insurance companies - the only major source o danger and damage you can't insure against, is damage caused by insutance companies.
A fried who's a GP in Durban tells me some of the Medical Aids are paying patients directly for his services, leaving it up to them to pay the doctor for the servies he has already provided - or not, if they choose to spend the cash on something else. Sounds odd, too.

Reply to cybershrink

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